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Ann Thorac Surg 1997;64:1220
© 1997 The Society of Thoracic Surgeons

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Correspondence

PTFE Membranes, Redo Operations, and Epicardial Echocardiography

Department of Cardiology, Wilhelmina Children's Hospital, 3501 Ca Utrecht, the Netherlands e-mail: nsreeram{at}wkz.ruu.nl

To the Editor:

Congenital open heart operations are often completed by placement of an expanded polytetrafluoroethylene (PTFE) membrane on the anterior aspect of the heart before sternal closure [1]. The principal advantage is that it prevents pericardial and mediastinal adhesions, thereby facilitating resternotomy. Recently, a 3-year-old male patient was reoperated on at our institution for pulmonary venous stenoses after previous neonatal repair of infracardiac total anomalous pulmonary venous drainage. At the original operation a PTFE membrane had been attached to the pericardium on both sides and inferiorly. After resternotomy the PTFE membrane was completely peeled away from the right atrium and ventricle. Resection of stenoses within the orifices of the individual pulmonary veins was then performed. Postbypass epicardial two-dimensional echocardiography using a standard 5-MHz ultrasound transducer was attempted to evaluate the repair. Placement of the probe on the anterior aspect of the right atrium or ventricle resulted in no two-dimensional images being obtained. Images of the heart could, however, be obtained by placement of the transducer superiorly, close to the roof of the right atrium or at the level of the great vessels. Portions of fibrous tissue could be peeled away from the right atrial and right ventricular epicardium. However, optimal imaging of the heart could still not be accomplished through these windows.

In a recently published multicenter study on the use of PTFE membranes, it was concluded that the PTFE membrane characteristically shows no tissue ingrowth and provides a clear plane of cleavage at the interface between the membrane and myocardium [2]. However, no histologic assessment of myocardial tissue underlying the membrane was performed. Despite the absence of histologic confirmation in our patient, we submit that PTFE membranes may produce a chronic inflammatory reaction in the underlying myocardium. This may be partially responsible for obscuring surface landmarks such as the course of the superficial coronary artery branches. It can also result in loss of the normal imaging windows for epicardial echocardiography. This severely limits the application of this technique for intraoperative assessment of surgical repairs, which may be particularly important for complex reoperations.

References

1. Amato JJ, Cotroneo JV, Galdieri RJ, Alboliras E, Antillon J, Vogel RL. Experience with the polytetrafluoroethylene surgical membrane for pericardial closure in operations for congenital cardiac defects. J Thorac Cardiovasc Surg 1989;97:929–34.
2. Jacobs JP, Iyer RS, Weston JS, et al. Expanded PTFE membrane to prevent cardiac injury during resternotomy for congenital heart disease. Ann Thorac Surg 1996;62:1778–82.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Narayanswami Sreeram Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hitchcock, F. J. Articles by Sreeram, N. Search for Related Content PubMed PubMed Citation Articles by Hitchcock, F. J. Articles by Sreeram, N.